A recent study found that people who are continuously enrolled in Medicare Advantage (MA) are less likely to die in a hospital than people continuously enrolled in Medicare fee-for-service. Researchers analyzed differences in the location of death (e.g., hospital, home) and found that:
- Medicare Advantage enrollees were 43 percent less likely to die in a hospital
- Medicare Advantage enrollees with cancer were nearly 80 percent less likely to die in a hospital
- Higher wealth and education are associated with increased hospice use and reduced odds for dying in hospital
“Hospice care is carved out of Medicare Advantage, so health plans are not responsible for enrollees’ costs once they enroll in hospice care.”
This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (MA) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study (n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting).
Logistic regression estimated the odds of dying in hospital for those continuously enrolled in MA from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in MA contracts may reduce the odds of dying in hospital.
The study was conducted using data on Medicare beneficiaries from the Health and Retirement Study who died between 2008 and 2010.
Financial incentives in Medicare Advantage may be one of the reasons why the odds of dying in a hospital are lower for enrollees. Hospice care is carved out of Medicare Advantage, so health plans are not responsible for enrollees’ costs once they enroll in hospice care. Once beneficiaries are admitted into hospice care, Medicare Part A is responsible for the costs. This policy may encourage health plans to promote hospice care.
Source: Elizabeth Edmiston Chen and Edward Alan Miller, Research on Aging, “A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare,” May 2016.
Lisa Remington is president of the Remington Health Strategy Group and publisher of the Remington Report magazine and has worked with more than 6,000 organizations in both a consultancy role and educator. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum.